Provider Demographics
NPI:1518227974
Name:REID, JERIANN MARIE
Entity type:Individual
Prefix:
First Name:JERIANN
Middle Name:MARIE
Last Name:REID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2739 W I 240 SERVICE RD APT F
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-3778
Mailing Address - Country:US
Mailing Address - Phone:405-680-5990
Mailing Address - Fax:
Practice Address - Street 1:2739 W I 240 SERVICE RD APT F
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-3778
Practice Address - Country:US
Practice Address - Phone:405-680-5990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-19
Last Update Date:2012-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health